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Graves’ thyrotoxicosis and coronary artery spasm

Department of Endocrinology, University Hospital of Wales, Cardiff, UK

Correspondence to:
Dr Richard Chudleigh, Diabetes Research Unit, First Floor, Academic Centre, Llandough Hospital, Cardiff CF64 2XX, UK; rachudleigh@hotmail.com

Submitted 8 June 2007
Accepted 20 August 2007

Keywords: coronary artery spasm; Graves’ thyrotoxicosis; myocardial infarction

The first 150 words of the full text of this article appear below.

Thyrotoxicosis occurs in 2% of females.¹ Cardiac complications include arrhythmias and cardiomyopathy; coronary artery spasm is also recognised, although it has rarely been reported to cause myocardial infarction.

Diagnosis of coronary artery spasm depends on a good history and electrocardiographic findings. The transient nature and unpredictable occurrence of spasm can make this difficult. Ergonovine administered during angiography will provoke diagnostic coronary artery narrowing in up to 90% of cases of true coronary artery spasm.² When coronary artery spasm occurs during angiography, administration of sublingual or intracoronary nitrate will relieve spasm in the majority of cases.³

We report two subjects who developed acute myocardial infarction associated with thyrotoxicosis. Further evaluation suggested coronary artery spasm as the mechanism of myocardial ischaemia.

	CASE 1

 
A 36-year-old woman presented with a 48 h history of chest pain, together with progressive left sided weakness. Her history included Graves’ thyrotoxicosis which had been treated with radioactive . . . [Full text of this article]